Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times
Journal
Medwave
ISSN
0717-6384
Date Issued
2022
Author(s)
Francisco Ríos-Castro
Felipe González-Seguel
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:p>Technological advances in mechanical ventilation have been essential to increasing the survival rate in intensive care units. Usually, patients needing mechanical ventilation use controlled ventilation to override the patient’s respiratory muscles and favor lung protection. Weaning from mechanical ventilation implies a transition towards spontaneous breathing, mainly using assisted mechanical ventilation. In this transition, the challenge for clinicians is to avoid under and over assistance and minimize excessive respiratory effort and iatrogenic diaphragmatic and lung damage. Esophageal balloon monitoring allows objective measurements of respiratory muscle activity in real time, but there are still limitations to its routine application in intensive care unit patients using mechanical ventilation. Like the esophageal balloon, respiratory muscle electromyography and diaphragmatic ultrasound are minimally invasive tools requiring specific training that monitor respiratory muscle activity. Particularly during the coronavirus disease pandemic, non invasive tools available on mechanical ventilators to monitor respiratory drive, inspiratory effort, and work of breathing have been extended to individualize mechanical ventilation based on patient’s needs. This review aims to identify the conceptual definitions of respiratory drive, inspiratory effort, and work of breathing and to identify non invasive maneuvers available on intensive care ventilators to measure these parameters. The literature highlights that although respiratory drive, inspiratory effort, and work of breathing are intuitive concepts, even distinguished authors disagree on their definitions.</jats:p>
Subjects
proportional assist ventilation
;
pressure support ventilation
;
airway occlusion pressure
;
mechanical ventilation
;
diaphragm
;
p0.1
;
esophageal
;
weakness
;
failure
;
dyspnea
;
critical care
;
humans
;
pandemics
;
respiration, artificial
;
ventilators, mechanical
;
work of breathing
;
artificial ventilation
;
human
;
intensive care
;
mechanical ventilator
;
pandemic
;
physiology
;
work of breathing